(TRUTH INITIATIVE) – Smoking in the U.S. has dramatically declined in the last two decades, particularly among the country’s youngest residents. In 2000, 23 percent of teens smoked cigarettes. By 2016, the number had fallen to just 6 percent. While there is much to celebrate in the reduction, the average national rate hides a significant variation found within the country.
A collection of 12 contiguous states stretching from the upper Midwest to the South undermines this national achievement. In the region of the country we’ve termed “Tobacco Nation,” smoking prevalence exceeds not only the national average, but that of many of the most tobacco-dependent countries in the world.
Residents of this region are less well-off financially than those in the rest of the U.S., and consequently spend a higher percentage of their disposable income on harm-causing tobacco. Health outcomes in Tobacco Nation are also relatively poor and access to care is more limited than in other parts of the country. Further compounding the problem is the relative lack of smoke-free laws and other tobacco-control policies designed to protect the public and encourage cessation. It should be no surprise that one of the major international tobacco companies recently declared the U.S. “an exciting opportunity for long-term growth.”
The overall picture that emerges is one of a significant portion of the U.S. that appears to have troubling similarities to less well-developed countries, which lack the income, infrastructure and health care resources to provide aid and support to their residents. Simply put, Tobacco Nation is a country within a country. And it is in trouble. The U.S. is already well below its high-income peers when it comes to life expectancy, ranking just 43rd among countries around the world, according to the World Health Organization (WHO). Reducing these disparities will require a serious effort that starts with reducing tobacco use.
Tobacco Nation is comprised of 12 states with the highest adult smoking prevalence: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Oklahoma, Tennessee and West Virginia. With more than 66 million residents, these states include roughly 20 percent of the U.S. population. As in other parts of the U.S., these states have slightly more females (51 percent) than males (49 percent) and over 20 percent of its residents are young people (aged 10-24).
Tobacco Nation is less diverse than the rest of the nation overall, with whites encompassing 75 percent of the region’s population (compared to 59 percent), African Americans comprising 15 percent (compared to 11 percent), Hispanics 5 percent (compared to 20 percent) and 4 percent “other” (compared to 9 percent).
Tobacco Nation is also not as well-off financially. On average, individuals living in Tobacco Nation earn nearly 21 percent less per year ($45,133) than the average resident within the rest of the U.S. ($56,852) (p < 0.001). In addition, 17 percent of its population lives below the poverty line of $24,600 per year for a family of four, compared to 15 percent of the rest of the U.S. population. Tobacco Nation provides evidence that the tobacco epidemic disproportionately burdens those least financially able to afford it. The population of this region is also less educated than the rest of the U.S. Only 22 percent of residents hold a college degree or higher, compared to 28 percent of the population in the other 38 states.
Residents of Tobacco Nation are slightly less likely to be engaged in the labor force (61 percent versus 64 percent of the rest of the U.S.) and are more likely to work in industries like manufacturing (14 percent versus 9 percent). They are also less likely to work in a professional, scientific or management position (9 percent) than the rest of the U.S. average (12 percent).
Adults (18 years of age and older) in Tobacco Nation are more likely to smoke than the average U.S. adult. Twenty-two percent of Tobacco Nation’s adults smoke, compared to 15 percent of adults in the rest of the U.S. The region’s youth also smoke at higher rates compared to the average U.S. youth aged 12-17 residing in one of the other 38 states (12 percent versus 9 percent).
Not only do Tobacco Nation’s youth and adults smoke at higher rates, their residents also smoke many more cigarettes per capita annually (66.6 packs) than those in the rest of the U.S. (40.6 packs). In practice, this could mean that over a given year, a person living in Tobacco Nation could be inhaling 500 more cigarettes than the average smoker in the rest of the U.S.—an addiction with serious consequences.
Study By: Truth Initiative, a non-profit group dedicated to making the US a smoke-free nation